East Region Formulary

Apply twice daily for 2-3 months

Apply twice daily, discontinue if no improvement after 1 month

For moderate to severe persistent facial erythema associated with rosacea. Patients should be reviewed after 1 month to determine benefits of ongoing treatment.

Apply once daily until erythema subsides, apply thinly, divide dose over forehead, chin, nose, and cheeks, max. 1g of gel per day.

For the treatment of moderate to severe inflammatory lesions of rosacea. Discontinue if no improvement after 3 months.

One application a day for up to 4 months.

Prescribing Notes:

Rosacea has four clinical variants (erythematotelangectasic, papulopustular, rynophymatous and ocular) and treatment should be targetted
Papulopustular Disease can be treated with a topical / oral agent or both.
Camouflage creams may be required for redness of the skin due to rosacea (see cosmetic camouflage section).
Mild rosacea is best treated with a topical agent. Topical agents should be used for 2-3 months then intermittently as required.
Azelaic acid gel is more cosmetically acceptable to patients, as moisturisers and make up can be applied on top of it.
Azelaic acid has antimicrobial and anticomedonal properties.
The pustules and papules of rosacea respond to topical metronidazole or to topical azelaic acid.
To avoid exacerbation or rebound symptoms of rosacea brimonidine gel should be initiated with a small amount of gel (less than the maximum dose) for at least 1 week and the dose then gradually increased based on tolerability and response to treatment. Patients should be advised to stop treatment and consult a doctor if their symptoms worsen during treatment (increased redness or burning).

History Notes

05/10/2022

Prescribing notes updated

15/12/2021

East Region Formulary content agreed.

408mg daily for 2-3 months

100mg once daily for 2-3 months

Erythromycin is a less cost effective choice than lymecycline or doxycycline but is licensed for rosacea

500mg twice daily for 2–3 months

Prescribing Notes:

There is no effective treatment for redness of the skin due to rosacea; camouflage creams may be required (see cosmetic camouflage recommendations). Brimonidine 3mg/g gel (Mirvaso) applied once daily may be used in patients with moderate to severe persistent facial erythema associated with rosacea for as long as facial erythema is present.
Pustular rosacea is best treated with systemic antibiotics. If no improvement after 3 months, the patient should be switched to an alternative antibiotic.

History Notes

15/12/2021

East Region Formulary content agreed.

Rosacea is rare in children consider seeking specialist advice.

Apply twice daily for 2-3 months.

Prescribing Notes:

The adult form of rosacea rarely occurs in children. Persistent or repeated use of potent topical corticosteroids may cause periorificial rosacea (steroid acne). The pustules and papules of rosacea may be treated for at least 6 weeks with a topical metronidazole preparation, or a systemic antibacterial, seek specialist advice prior to starting systemic therapy.
Camouflage creams may be required for redness of the skin due to rosacea (see Cosmetic camouflage section).

History Notes

31/05/2024

East Region Formulary content agreed.

Prescribing Notes:

Consider diagnosis and seek specialist advice prior to initiating systemic therapy for a child.

History Notes

31/05/2024

East Region Formulary content agreed.